Provider Demographics
NPI:1225204902
Name:CHERRY LANE MEDICAL SUPPLY
Entity type:Organization
Organization Name:CHERRY LANE MEDICAL SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ONYEKACHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGHA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-295-0803
Mailing Address - Street 1:14440 CHERRY LANE CT
Mailing Address - Street 2:SUITE 223
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4946
Mailing Address - Country:US
Mailing Address - Phone:240-295-0803
Mailing Address - Fax:187-729-5080
Practice Address - Street 1:8730 CHERRY LN
Practice Address - Street 2:10B
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-6212
Practice Address - Country:US
Practice Address - Phone:301-776-1903
Practice Address - Fax:301-776-1946
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHERRY LANE MEDICAL SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-02
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175280332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies